Background: Hypothyroidism is an unusual cause of ascites. Hypothyroidism may also mimic hepatic encephalopathy in patients with cirrhosis. Reversible, hypothyroidism-induced ascites and encephalopathy simulating liver failure in a patient with cirrhosis awaiting liver transplantation has not been reported.

Objective: To describe the resolution of intractable ascites and encephalopathy with treatment of hypothyroidism in a patient with cirrhosis awaiting transplantation.

Case Report: A 40-year-old woman with cirrhosis secondary to chronic hepatitis C virus infection had intractable ascites and encephalopathy. She was listed for liver transplantation at another institution. She presented for a second opinion to determine whether additional evaluation and treatment might preclude the need for transplantation.